SECTION 380.207. Program Limitations

In the following circumstances clients are not eligible to receive transportation services:

(1) transportation to and from a day activity, a personal care home or state institution, or a facility participating in another Title XIX program for which the reimbursement rate structure includes transportation funds;

(2) the intended destination is a nursing facility, except as specified in §380.202(5) of this subchapter (relating to Program Services);

(3) the client is an inpatient in a health care facility, except as specified in §380.202(5) of this subchapter;

(4) the client is under 15 years of age and:

(A) the client's parent, guardian, or another adult authorized by the parent or guardian does not accompany the client as required by §354.1133 of this title (relating to Parental Accompaniment Requirement); and

(B) the parent or guardian, if authorizing another adult to accompany the client, has not provided written authorization on a form prescribed by the Health and Human Services Commission, which will allow for the designation of one authorized adult and one alternate authorized adult;

(5) the client is 15 through 17 years of age and not accompanied, unless one of the following conditions exists:

(A) the client presents the parent's or legal guardian's signed, written consent for the transportation services to Medical Transportation Program staff, or a transportation provider; and/or

(B) the treatment to which the minor is being transported is such that the law extends confidentiality to the minor for this treatment;

(6) the client or another person or entity providing care for the client receives direct payment of worker's compensation benefits, U.S. Department of Veterans Affairs benefits, or other third-party resources for transportation to health care services on the client's behalf;

(7) the client is on limited status, unless the provider has made the referral or the client requests family planning services;

(8) TICP diagnostic visits and/or cancer or cancer-related treatments that are provided out-of-state;

(9) the client and/or attendant intentionally, knowingly, or recklessly boards the vehicle carrying an illegal knife, a club, handgun or other weapon, as defined in Penal Code, §46.01, on or about his or her person;

(10) a third-party, such as a lodging establishment, provides transportation, meals, and/or lodging at no charge for a client and attendant, for a particular appointment; or

(11) an attendant does not accompany the client on the MTP-requested trip when a Health Care Provider's Statement of Need, Form 3113 or equivalent, is on file stating the client requires an attendant(s).

Source Note: The provisions of this §380.207 adopted to be effective April 10, 2001, 26 TexReg 2720; amended to be effective May 11, 2003, 28 TexReg 3722; transferred effective March 1, 2004, as published in the Texas Register April 30, 2004, 29 TexReg 4267; amended to be effective September 13, 2004, 29 TexReg 8796; amended to be effective January 1, 2013, 37 TexReg 10192; amended to be effective September 1, 2014, 39 TexReg 5731